Tuesday, October 24, 2017

Family in dispute over care of woman with brain damage

Court told by partner and daughters that Mrs P would want to die in such circumstances, while sisters want artificial feed to continue

A family is in dispute over the ongoing care of a woman with brain damage who had suggested she would want to die in such circumstances, a court has heard.

The woman, identified as Mrs P, is said to be in a “minimally conscious state” on an acute hospital ward following a fall last year. A Court of Protection judge is being asked to consider whether she should continue to receive clinically assisted nutrition and hydration.

The woman’s daughters and her partner consider it would not be in her best interests and that she should be provided with palliative care. But her sisters disagree and say an artificial feed should be maintained to see whether she might improve.

A judge in Preston was told on Monday of an email that Mrs P sent to one of her daughters more than three-and-a-half years before her fall.

It read: “Did you see that thing on dementia? Made me think of dad and what a travesty of life his last years were all the sadder as he had such an incredible talent.

“You know I miss Mum everyday and still talk to her but it is a comfort that she went quickly and I’m still haunted by how he ended up ... Get the pillow ready If I get that way?”

However, her sisters insist their sibling would want the opportunity to potentially get better. One sister thought the withdrawal of feeding would be a form of “legalised killing”, the court heard, while another said the medical profession should be the judge of what treatment is provided.

The NHS foundation trust that is treating Mrs P, which cannot be identified, has applied to the court to continue providing clinical treatment and transfer her to a specialist nursing home.

Joseph O’Brien, for the trust, told the judge, Mr Justice Hayden: “Very early on, Mrs P’s daughters were expressing the view to the clinicians that she would not wish to have any treatment which would continue her existence, her life, if she in fact was suffering from brain damage.”

He said witness evidence from friends and neighbours, with recollections of specific conversations, would also set out what Mrs P would wish to happen to her “in the event she found herself either with dementia or with any cognitive problems”.

But he added: “There is a strong presumption about the preservation of life.

“On the evidence we’ve seen so far there is nothing that’s strong enough to rebut the notion that in the circumstances she currently finds herself, she would wish treatment to be discontinued.”Two medical experts who examined Mrs P’s case agreed there would be no further change in her underlying neurological and neurophysiological state.

They also agreed there would be no significant improvement in underlying levels of awareness and responsiveness.

But they had different opinions on whether nutrition and hydration should continue. One said she believed there was a reasonable prospect that in a different environment Mrs P would become more interactive with other people, and that Mrs P did at times show pleasure and engage with therapy, nursing and medical staff.

But the other expert felt that Mrs P showed evidence of distress and not wishing to engage socially, at least from time to time. He did not agree that there would be a marked improvement in Mrs P’s level of social engagement and quality of life in a different setting.

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